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62 Cards in this Set

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Spring ligament
Inferior and superomedial calcaneonavicular ligaments. Help support longitudinal arch
Lisfranc ligament
2nd metatarsal to medial cuneiform. Plantar strongest part
Components of transverse tarsal joints
talonavicular and calcaneocuboid- parallel during eversion/ divergent during inversion
Stride
heel-strike to heel-strike. 62% stance/ 38% swing. Stance phase decreases with increasing speed.
Foot changes from heel-strike to toe-off
1. plantar fascia tightens as MTPJ extends. 2. Longitudinal arch accentuated. 3. PTT supinates hindfoot. 4. Transverse tarsal joint locks--> rigid lever arm
Cutaneous nerves of the foot
1. sural- lateral border. 2. Saphenous- medial eminence of great toe. 3. Medial dorsal cut br SPN- dorsomedial foot. 4. Intermediate dorsal cut br SPN- Dorsolateral foot. 5. DPN- 1st dorsal webspace. 6. Posterior tibial- plantar foot
Canale view- foot XR
15 degrees internal rotation- talar neck fx
Harris view- foot XR
Axial heel view
Broden's view- foot XR
Subtalar medial oblique at 10 deg
Location of hallux sesamoids
in FHB
Hallux valgus interphalangeal angle
<8deg
Hallux valgus angle
<15 deg
Metatarsus primus varus angle
1st MT vs medial cuneiform. <25deg
1st IMA
<10 deg
DMAA
<15deg
Complications Keller resection arthroplasty
transfer metatarsalgia, loss of weight bearing function, cock-up toe deformity. Salvage w/ 1st MTPJ arthrodesis +/- interpositional graft
Silver bunionectomy
medial eminence resection + distal soft tissue release.; High risk of recurrence
Position 1st MTPJ arthrodesis
110deg dorsiflexion relative to floor/ 25deg dorsiflexion relative to 1st MT/ 10-15deg valgus
Treatment hallux varus
AbHL release/ Tx EHL or EHB under IM lig to proximal phalanx. Fusion if fixed
Assess flexibility of lesser toe deformities
Push up test. Pressure on plantar forefoot reduces deformity- removes overactive intrinsics
Mallet toe
flexion deformity DIPJ. 2/2 overactive FDL. Tx: FDL tenotomy/ excisional arthroplasty if rigid.
Claw toes
Usually neurologic origin. Tx: flexor to extensor transfer + EDB tenotomy/EDL lengthening. If fixed-resection arthroplasty or PIP arthrodesis. Weil osteotomy (oblique shortening MT osteotomy) increases correction.
Treatment flexible hammer toes
FDL flexor to extensor tendon transfer. Add EDL lengthening/tenotomy if active flexion <10-15deg
Treatment flexible mallet toe
Percutaneous FDL tenotomy
Treatment crossover 2nd toe
Extensor tenotomy, dorsa/medial MTPJ capsule and MCL release
Treatment overlapping 5th toe
Capsule release, Z-plasty dorsal skin, EDL lengthening
Treatment underlapping 5th toe
Kids- FDL/FDB tenotomy. Adults- flexor to extensor transfer, syndactylization
Etiology crossover 2nd toe
Attritional rupture LCL/lateral capsule + attenuation 1st dorsal IO/plantar plate
Proximal osteotomies for bunionette deformity
AVOID- tenuous blood supply to proximal metadiaphyseal junction
Complications sesamoid excision
Medial: hallux valgus; Lateral: hallux varus; Both: cock-up deformity
Location interdigital neuroma
Between 3rd and 4th metatarsal.
Recurrent metatarsal neuroma
Secondary to traction neuritis due to neural stump adherence. Tx: excision- plantar or dorsal incision. 65-75% success rate
Tarsal tunnel syndrome
Compression posterior tibial nerve. Increased risk w/ pes planus/ hindfoot valgus.
Anterior tarsal tunnel syndrome
Compression DPNunder inferior extensor retinaculum. Cause: tight shoes/ anterior osteophytes/pes cavus/tendinitis. Sx worse w/ ankle plantarflexion and toe extension. Tx: night splints/ shoewear modifications/retinacular release w/ bone spur excision- relief may take months
Treatment adolescent CMT w/ supple deformity
1. plantar fascia release. 2. closing wedge dorsiflexion osteotomy 1st MT. 3. calcaneal slide and closing wedge osteotomy. 4. transfer PL to PB at distal fibula. 5. TAL
Treatment clawed hallux
arthrodesis of IPJ and transfer EHL to 1st MT
Position ankle arthrodesis
5deg DF/ 5-10deg ER/ neutral varus and valgus
Position subtalar arthrodesis
10deg valgus/ 0deg rotation
Position talonavicular arthrodesis
0 deg varus/valgus hindfoot; 0 deg Meary's angle
Stage I PTT dysfunction
pain- nml alignment. Bracing/ synovectomy
Stage II PTT dysfunction
Flexible pes planovalgus. UCBL orthosis/ AFO/TAL; FDL transfer; medial calc slide
Stage III PTT dysfunction
Rigid deformity. Hindfoot arthritis. Triple arthrodesis + TAL/gastroc slide
Stage IV PTT dysfunction
Ankle involvement. Triple arthrodesis + TAL+ deltoid reconstruction
Unilateral cavus foot
R/o intraspinal etiology
Initially affected muscles CMT
TA/ EDL/ PB
Most common location stenosing tenosynovitis of FHL
bet posterolateral and posteromedial tubercles of talus
Achilles debridement over 50%
Need augmentation w/ tenodon transfer (FHL)
ABI
1.0= nml/ 0.45 needed for wound healing
Toe pressures
100mmHg=nml/ 40mmHg needed for healing
TcPO2
>40mmHg predictive of healing
Cuboid syndrome
Subluxation. More common in ballet dancers. Pain/ click when foot dorsiflexed/everted
Joint where most hindfoot motion occurs
talonavicular
Cause navicular avulsion fx
forcible contraction tibialis posterior
Treatment navicular body fracture
ORIF even if non-displaced
Blood supply to talus
posterior tibial/ dorsalis pedis/ perforating peroneal. Artery of tarsal canal is main supply esp to body. Artery of tarsal sinus/ DP important for head/neck
Malunion talar neck fractures
Varus deformity most common- more if medial comminution. Causes cavus/supination of foot--> tx w/ medial column lengthening/lateral column shortening/talar neck osteotomy
Reduction talar neck fractures
Plantarflexion and manipulation of heel. Immediate reduction necessary.
Anterior process of calcaneus fracture
Avulsion of bifurcate ligament. Fix or excise if displaced over 1cm
Most common location intra-articular calcaneus fractures
posterior facet
Normal Bohler's angle
25-40deg
Compartments of the foot
medial: AbH/FHB. Central: FHB,lumbricals,QP, AdH. Lateral: flexors, abductors, opponens of 5th toe. Interosseous compartment.
Risk of compartment syndrome w/ calcaneus fracture
10%